If you rent, please list the name and telephone number for your landlord so we may verify your lease allows pets.

Is your yard fenced in?

Yes

No

If Yes, What type of fencing?

How long Have You Lived at Your Current Address?

Do You Plan On Moving In the Near Future?

Do You Have Children?

Yes

No

If Yes, What are their Names & Ages?

Do You Have Other Pets?

Yes

No

If Yes, What Type? Please List ALL:

Are ALL of Your Pets Current on Their Vaccines

Yes

No

Are ALL of Your Pets Spayed or Neutered:

Yes

No

If You Answered “NO” to either of the above questions, please explain:

Who is Your Current Veterinarian?

Veterinarian Phone Number

Veterinarian Phone Number

(###)

###

####

May We Contact Them?

Yes

No

Text Area *

I Understand that by entering my name below, I am releasing Phoenix Rising from further responsibility of the specified animal upon completion of adoption. I understand that the adoption fee I am paying covers vaccines, initial de-worming and spay/neuter. Any further medical needs of this pet are now my responsibility. Phoenix Rising cannot be held liable or responsible for the care of this pet beyond what is specified.